Background. As the nation's dominant purchaser of vaccines and supporter of immunization services, the Centers for Disease Control and Prevention have an ongoing need for objective economic information about new vaccines and vaccine programs. Specific Aims. For the past 3 years, we have been conducting collaborative research in vaccine economics with CDC colleagues via the Joint Initiative in Vaccine Economics (JIVE) Project. We propose to continue this project, initiating 4 new studies during the coming 3 years. We will: 1. Conduct the Zoster Utilities Evaluation, a study of utilities (preferences) for health outcomes associated with adult zoster and varicella vaccination of adults. These utilities will provide key data for analyses of the benefit-risk tradeoffs and the cost-effectiveness of vaccinating adults against zoster. 2. Carry out an applied study in vaccine economics that addresses a top-priority question in global infectious disease policy; 3. Design and lead an economic study to inform policy decisions for influenza vaccination; 4. Conduct an economic study that addresses an emerging immunization services policy question. Methods and Study Design. For the Zoster Utilities Evaluation (Specific Aim 1), we will use a prospective cohort design and will conduct telephone interviews with two subgroups: (1) Recent-zoster patients - adults who have recently had zoster or post-herpetic neuralgia; and (2) Community representatives - adults selected at random from health plan populations. The study population will be identified using the computerized databases of Harvard Vanguard Medical Associates and Northern California Kaiser Permanente. We will administer a structured, closed-ended interview that includes standard gamble and/or time trade-off questions about utilities for health states associated with zoster and adult varicella vaccination, as well as important predictor variables. Statistical analyses will use nonparametric bivariate tests and multivariate models. We will test the hypothesis HI: Zoster-associated pain will be rated worse by patients who have recently experienced zoster than by adult community members. For Specific Aims 2, 3, and 4, we will select and develop the specific research questions in collaboration with CDC colleagues during the first three months of the timeline. We will choose methods appropriate for the research questions selected. Project Management and Collaborative Efforts. The investigators are uniquely qualified to conduct this work. This is a multidisciplinary team based at Harvard with advanced skills in decision analysis, a recommended method of evaluating the benefits, risks, and economic effects of health policies. The Harvard-based project leaders are Tracy Lieu, MD, MPH, a pediatrician and researcher with a decade of experience in vaccine economics; Kim Thompson, PhD, a risk and decision sciences researcher with experience in global infectious disease analyses; Lisa Prosser, PhD, a health economics researcher with advanced skills in utility assessment; and Grace Lee, MD, MPH, a pediatric infectious disease specialist with expertise in cost-effectiveness analysis. This team has been highly productive in current collaborations with CDC colleagues on the cost-effectiveness of vaccination policies for pertussis, influenza, polio, and hepatitis B. Anticipated Policy Impact. This research will provide key data to inform important vaccine policy decisions, including the question of whether to vaccinate adults against zoster. By continuing our collaborative work with CDC colleagues, we will address the long-term goals of enhancing the nation's capacity and methodology for answering important economic questions about vaccines and other health interventions.